The Next-Generation Surgical Robots

The chronicle of surgical robots is short but remarkable. Within 20 years since the regulatory approval of the first surgical robot, more than 3,000 units were installed worldwide, and more than half a million robotic surgical procedures were carried out in the past year alone. The exceptionally high speeds of market penetration and expansion to new surgical areas had raised technical, clinical, and ethical concerns. However, from a technological perspective, surgical robots today are far from perfect, with a list of improvements expected for the next-generation systems. On the other hand, robotic technologies are flourishing at ever-faster paces. Without the inherent conservation and safety requirements in medicine, general robotic research could be substantially more agile and explorative. As a result, various technical innovations in robotics developed in recent years could potentially be grafted into surgical applications and ignite the next major advancement in robotic surgery. In this article, the current generation of surgical robots is reviewed from a technological point of view, including three of possibly the most debated technical topics in surgical robotics: vision, haptics, and accessibility. Further to that, several emerging robotic technologies are highlighted for their potential applications in next-generation robotic surgery

The future of robotic surgery

© 2018 Royal College of Surgeons.For 20 years Intuitive Surgical’s da Vinci® system has held the monopoly in minimally invasive robotic surgery. Restrictive patenting, a well-developed marketing strategy and a high-quality product have protected the company’s leading market share.1 However, owing to the nuances of US patenting law, many of Intuitive Surgical’s earliest patents will be expiring in the next couple of years. With such a shift in backdrop, many of Intuitive Surgical’s competitors (from medical and industrial robotic backgrounds) have initiated robotic programmes – some of which are available for clinical use now. The next section of the review will focus on new and developing robotic systems in the field of minimally invasive surgery (Table 1), single-site surgery (Table 2), natural orifice transluminal endoscopic surgery (NOTES) and non-minimally invasive robotic systems (Table 3).Peer reviewedFinal Published versio

Snake-Like Robots for Minimally Invasive, Single Port, and Intraluminal Surgeries

The surgical paradigm of Minimally Invasive Surgery (MIS) has been a key driver to the adoption of robotic surgical assistance. Progress in the last three decades has led to a gradual transition from manual laparoscopic surgery with rigid instruments to robot-assisted surgery. In the last decade, the increasing demand for new surgical paradigms to enable access into the anatomy without skin incision (intraluminal surgery) or with a single skin incision (Single Port Access surgery - SPA) has led researchers to investigate snake-like flexible surgical devices. In this chapter, we first present an overview of the background, motivation, and taxonomy of MIS and its newer derivatives. Challenges of MIS and its newer derivatives (SPA and intraluminal surgery) are outlined along with the architectures of new snake-like robots meeting these challenges. We also examine the commercial and research surgical platforms developed over the years, to address the specific functional requirements and constraints imposed by operations in confined spaces. The chapter concludes with an evaluation of open problems in surgical robotics for intraluminal and SPA, and a look at future trends in surgical robot design that could potentially address these unmet needs.Comment: 41 pages, 18 figures. Preprint of article published in the Encyclopedia of Medical Robotics 2018, World Scientific Publishing Company www.worldscientific.com/doi/abs/10.1142/9789813232266_000

Intelligent Information-Guided Robotic Surgery

Laparoscopic surgery is minimally invasive, providing various benefits for patients. On the other hand, it is technically demanding for physicians due to limited dexterity of tools, limited vision. In order to cope with those limitations, recent various engineering technologies are trying to help surgeon. Robotics is one of the major technologies in this field. Until today, da Vinci has been only one such robot. But recently, many other robotic systems are under development. Those new robots are introduced in this chapter first. Other than robotics, or in conjunction with robotics, navigation technologies are getting popularity in clinical use. Navigation is a technology that provides useful information such as preoperative images or distance between tool and lesion, etc. to surgeon. Our experience in clinical use of navigation system in robotic surgery is introduced. Finally, technologies applied for the training of surgeon are introduced and described

User-centred system design approach applied on a robotic flexible endoscope

AbstractComplex systems, like surgical robots, are designed by engineers. It is very difficult for them to determine the different needs and desires of all stakeholders. Especially when designed from scratch, end user input is essential in creating a system that has added value, is user friendly, and can be easily integrated into practice. For the development of a robotic flexible endoscope we have involved physicians, nurses, and equipment suppliers in our design approach. Seven steps are executed to convert user preferences and capabilities into concepts:•Determine focus area of development.•Create the current workflow of system application to understand (the context of) use.•Determine problem definition and design goal.•Create the future workflow, in which current problems are eliminated and major system wishes are fulfilled.•Translate the future workflow into a functional overview that contains system functions.•Select and configure the appropriate construction elements into physical overviews, being preliminary concepts.•Decompose physical overview into manageable modules.These views are evaluated by the major stakeholders and together form a system architecture. The system architecture helped us in defining the robotic modules required to fulfill all stakeholders‟ needs and desires. Demonstrators were built to evaluate critical concepts in clinical relevant experiments

Elongation Modeling and Compensation for the Flexible Tendon-Sheath System

In tendon-driven systems, the elongation of the tendon would result in inaccuracy in the position control of the system. This becomes a critical challenge for those applications, such as surgical robots, which require the tendon-sheath system with flexible and even time-varying configurations but lack of corresponding sensory feedback at the distal end due to spatial restrictions. In this paper, we endeavor to address this problem by modeling the tendon elongation in a flexible tendon-sheath system. Targeting at flexibility in practical scenarios, we first derived a model describing the relationship between the overall tendon elongation and the input tension with arbitrary route configurations. It is shown that changes in the route configuration would significantly affect the tendon elongation. We also proposed a remedy to enhance the system tolerance against potential unmodeled perturbations along the transmission route during operation. A scaling factor S was introduced as a design guideline to determine the scaling effect. A dedicated platform that was able to measure the tensions at both ends and the overall tendon elongation was designed and set up to validate the new findings. Discussions were made on the performance and the future implementation of the proposed models and remedy.published_or_final_versio

Natural Orifice Translumenal Endoscopic Surgery of the GastroIntestinal Tract

Research Focus - NOTES is a new technique that faces numerous challenges. Current technology, training and research activities are conducted to make it a safe and effective minimal access technique